哮喘的小气道炎症（科内稿）课件.pptVIP

* Jenkins HA, et al. Histopathology of severe childhood asthma: a case series. Chest. 2003;124:32-41. * Hamid Q,et al. Inflammation of small airways in asthma.J Allergy Clin Immunol. 1997 Jul;100(1):44-51. 这个研究比较了因癌症需要肺切除的哮喘患者和对照组（非哮喘患者）肺标本组织中炎症细胞及其标志物，发现哮喘患者中央气道和远端气道都比对照组有显著存在连续炎症浸润。（肺切除术后）A=6,C=10 In lung tissue from asthmatic and control subjects undergoing surgery, the number of T cells, and eosinophils (MBP and EG2) are increased in the proximal and distal lung in asthmatics, suggesting a continuum of inflammation throughout the airway. * Balzar S, et al. Transbronchial biopsy as a tool to evaluate small airways in asthma. Eur Respir J 2002;20:254–259 Distribution of inflammatory cell counts in medium airways, large airways, small airways and alveolar tissue. The distribution of inflammatory cell counts in MA, LA, SA and AT are shown in figure 3. The overall difference among inflammatory cell counts in the three airway sizes and AT was significant (p =0.008). The inflammatory cell count in SA (median 1011·mm-2(interquartile range 539–1290)) was significantly higher(p0.05) than in MA (346·mm-2 (223–415)) and LA(332·mm-2(189–416)), and not different (p=0.09) from AT (464·mm-2(298–834)). * * Hamid 等使用免疫细胞化学在哮喘患者的肺组织中检测炎症标志物如T细胞、嗜酸细胞和肥大细胞，结果发现内径小于2mm的小气道受炎症的影响程度严重于中心气道（2mm）。 直接比较大气道和小气道发现，2mm的气道中可见更多的嗜酸细胞，提示小气道中存在与大气道显示且更严重的炎症反应。 气道重塑并不限于器官和细支气管-慢性炎症也会导致小气道壁增厚。 参考文献 Contoli M, et al. The small airway and distal lung compartment in asthma and COPD: a time for reappraisal. Allergy 2010;65:141-151. Hamid Q, et al. Inflammation of small airway in asthma. J Allergy Clin Immunol 1997;100:44-51. 查原文 Wagner EM, et al. Peripheral lung resistance in normal and asthmatic subjects. Am Rev Respir Dis 1990;141:584–588. 研究通过人体体积描记仪记录气道的气体流量，通过支气管镜测量压力 Pressure at the tip of the bronchoscope (PB)代表支气管镜顶端的压力，V 代表气体流量。左图显示的是流量压力关系图，实心方块为正常对照，空心方块为有症状的哮喘患者。由图可见，正常对照组气流量增加对气道阻力影响不大，而哮喘患者随气流增加，压力也明显增加。 methacholine PD20 代表导致FEV1下降20%的乙酰甲胆碱激发剂量 横坐标是其对数值 Rp代表外周肺阻力，1/Rp代表外周肺传导 右